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HomeMy WebLinkAboutPermit Electrical 2003-4-15 .. .' . 225 FIFTH;lTREET SPRINGFIELD, QREGON 97477 INSPECTION REQlWST: 726~37(j9 OFFICE: 726-37~9, . , .' EU:C._dCAL PERMIT APPLICATION 'City Job NU~bcrCt?m~ ODd/- 0001 6~) ~' ",~ 1. LOCATION OF INSTALLATION So (a';:) <;-' 'IT <:.. -h:e,. ''I A: LE~A4DESCRIPTION l"1DZ2B" l~ N\ ;L brc:;.cr'\c h. C\\ (\J \\-~ l D 1w New Residelltial-Single or . Multi-Family per dwelling unit. Service Included: Items Cost Sm:n JOB DFtS,Clp:RTION (] . 1000 sq. ft. or less H. V I't-C K. tl'.,t.E4fdllowina oroiec! as submitted hi&tl\eW~~1 500 zoning, and does not require spec!tq< 19trm-lf!AAtion Permits are non-transfe.rable amN!.~We. L ~ thereof If work IS not started wItlun 180 days Zoning 1) ~;,::h )A;,:;-//t'-4 Home or of issuance or if work is suspe~~ 'for t.f - 15" -{j '3 Modular Dwelling 180 days. d S' """"'-I bervice or Feeder Autrlonze Ignature ~ $106.00 $ 19.00 $ 50.00 2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders ATTENTIOr)l:Oreg~,' w reqUlres:vou to ~f'1. Installation, Alterations.or 1ol16W~ @l<ll1lpt<adr~~r~ab(.,l8f- 'I}. J/rJlJ Q Relocation: No~i~icl8ltion C T ose les. e set ~ in OAl*t<g~- . ("~?ffi,~" 200 amps or less ," $ 63.00 0090.'yeu ulay b",~ai,rt, CO,iSSO~%u,d~~,"",,"'" 201 amps to 400 amps' $75.00 C~ -, ,'1i. ~1ffi~delMph~0\ 401 amps to 600 amps $125.00 nU01lberfoHhia Orarnon fUliI!l .. . '., ..1l011 ' 61\!!l''\i!Jlll!itlOOO ampS 'fl1R'E J~~I!'1l( .si.IPeO(les,.no,(f"..rIC,I.Se"""I1",.s,~e6MOJ.l.",.~J.!:.~~L._ "." . ~ .,.orffI50P~Y1;~W~lM.LLE~ " ,'... - m li ; IX,?,.}.o p y;;l~,.;~. ., Re"c, onne.c"tr01'l"hn,."" 1,.1 ~\I,flER 1HIS, P, $ , .00 J . f J .1>\ I \ liUhlL.t::\.J UI~'1 . '," ,. . fO . ExpimtionDate, ' .! D-tI;'NO.".; .. .~f:>!CEOif'iSA31\I'lDONtU . Const(~onh. Numbel{ib~>3;h~)~G. . , i::i'~~~:;~~~,sAWi~li~~t;;;\~c.~tion .', "CZ" . Expiration Datei:' Z'4 , ";1';'- .~ ;":;.. . ; Signature of Supervising Electrician 200 amps or less 201 amps to 400 a.mps Over 401to'600 ainps Over 600 ampsor;,10QO volts see "B" above $50.00 $69.00 $100.00 PIt~J;J;.?~~~ 4 .;~lJCq:ers N~me .~~ I/e..,'.;l<?( ~ ; Lh . D. Bra~:'vCl~~~~:ion or Extension Per Panel - > I Address 35'74J e~;\'Ce};(OJJ/ DeLI- OneCircuif' O!*JCt{jf1I:~holl Lj ') - ~)4? OWNER INSTALLATION The installation is. being made on property I o-\.vn wl}ichis not int)lnded . for sale, lease or renL ) .J (jU $43.00 LfJ. Each Additional Circuit or with Service .3 {1O or Feeder Permit I $ 3.00 . E. Miscellaneous (Service/feeder not included) -Each iI1stallation, .'. Pump 'oriirigation . Sign/Outline Lighting Limited EnergyIRes Limited Energy/Comin $50.00 $50.00 $25.00 $45.00. Minimum Elech:icPermit Inspection Fee is S45.00 + Surcharges . ,()1) 4, SUBTOTALOF ABOVE ~ ~ . -'T%-'State.S~rch~rge . ti ...3 ,~ ~ '--8'%1\dmmlstratlVe Fee I D h&...;. (,." t1 TOTAL s:? .3' ~ ~ RECEIPT FOR PAYMENT CONSTRUCTION CONTRACTORS BOARD Received from:~ n./'V'SS' ~ ", ~;,,^~r .)r License I Enforcement No.: AA 8 ~ Phone ,5<f \ ,9- 'TD -(9 -nO<. TYPES: General - All Structures D General - Residential D Specialty - All ~ Specialty - Residential D Limited Contractor 0 lnspector 0 FOR: New License---------------- 0 Renewal--------------------- ~ Reissue---------------------- 0 La te F ee--------------------- 0 Lead Base Paint----------- 0 HIAC App------------------ 0 Enforcement Penalty----- D Inactivate / Reactivate---- 0 Other 0 Amount Paid: $-.?\D.. Form of Pavment: '" Cash ------------- 0 Check # IJ Money Order----- 0 Received B; tA ,~ ~ . '" 250 / 256 251 / 257 2-1 I 1-8 ~- -~ 253 / 259 254 / 260 255 / 261 o Pendino o . ):Q Effective ~- c9 1-1- 03 ~,.. Q l-{ _~r--- ..lsIs Exempt ~....."m '."m o Non-Exempt $100 x $ 20 x $ 5x A~~ $50 x SIO x $ I x av::r~ \rr Cashier's Check------------------ 0 Travelers Check------------------ 0 V isa/MasterCa rd/Discover--~ , Date L- ~ 10' <:s (Stall' GIV<: copy to ~W>lOmCL Attach nnginal of receipt 10 money and documcntallon. ) Rl.:t.:C:pl J,)\'; 07 !Oa;02 ,,_I'" -' r License Number: License Status: License Category: License En~ity: Name/Address: Work Phone Number: Assumed Business Name First Licensed: Expiration Date: Employer Status: Bond Company Name: Amount: Bond Effective To: Insurance Company Name: Amount: Insurance Effective To: Other License Numbers: Page 1 of 1 Construction Contractors Board PO Box 14140 Salem OR 97309-5052 503-378-4621 ext. 4900 10-APR-03 89886 Active Specialty Contractor/All . Individual JAMES T FARMER JR 92863 AL V ADORE ROAD JUNCTION CITY OR 97448 541-998-6772 FARMERS ELECTRIC REFRIGERATION & H* .03/24/1993 03/24/2005 EXEMPT MID CENTURY INSURANCE CO $10,000 03/24/2005 ASSURANCE CO OF AMERICA (NY) $1,000,000 03/24/2004 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00250 ISSUED: 04/11/2003 APPLIED: 04/08/2003 EXPIRES: 10/11/2003 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5625 E ST ASSESSO~~r~R<f~9<-egl>7PW~W8s you to F"'JQJ R,\)', rules adopted by the Oregon Utility PROJE'NOtl '15hlM~1Cg~r.~~Ef:Yf1lW are set fort~ :_ ,/"'1, ^ D nl::"_t')n1_nn1nthrOllnh OAR ~52-001 Owner: OO~~IilllWA~ain copies of the rules b) Address: 3fi~<t1JjI)~~: 1$Btu~~1~ OR 97478 :"'/l.-.~,:,..f,:,..+h'" nro~nn Iltilit}' N('\tifi~;::ttion Center is 1-800-332-23r~ONTRACTO' Wf~ATION I 1 I . Contractor Type Contractor THIS PER~ltalHALL EE~mf~ficT$lIP~RKPhone Electrical JAMES T FARMER JR AUTHORIA&'B8'lJNDER THIS 'f-ltffl~A01S NOT 541-915-4883 Mechanical DEAN M SCHULTZ COMMENlJlUUR IS ABAN19~~aoPFJR 541-767-0626 Owner KINTIGH DAVE ANY 180 DAY PERIQD BUILDING INFORMATION I Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential VN # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 SETBACKS I DEVELOPMENT INFORMATION I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: Pae:e 1 of 3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I Description Tvpe of Construction $ Per Sq Ft Square Footal!e Total Value of Project ~ Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Air Handling Unit Up to 10,000 Furnace - up to 100,000 btu Heat Pump Minimum/Adjustment Mechanical + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Pai $10.00 $4.50 $3.15 $8.00 $12.00 $12.00 $13.00 $4.60 $3.22 $43.00 $3.00 4/8/03 4/8/03 4/8/03 4/8/03 4/8/03 4/8/03 4/8/03 4/11/03 4/11/03 4/11/03 4/11/03 Total Amount Paid $116.47 I Plan Reviews I CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00250 ISSUED: 04/11/2003 APPLIED: 04/08/2003 EXPIRES: 10/11/2003 VALUE: Value Date Calculated Receipt Number 2200200000000000713 2200200000000000713 2200200000000000713 2200200000000000713 2200200000000000713 2200200000000000713 2200200000000000713 2200200000000000732 2200200000000000732 2200200000000000732 2200200000000000732 To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. UleouiredJ nsnections I 1 Rough Mechanical: Prior to Cover 2 Final Mechanical: When all mechanical work is complete. 3 Final Electric: When all electrical work is complete. 4 Rough Electric: Prior to Cover Pal!e 2 of 3 Status Issued CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2003-00250 ISSUED: 04/11/2003 APPLIED: 04/08/2003 EXPIRES: 10/11/2003 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date Pa2e 3 of 3 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Line Items: Job/Journal Number COM2003-00250 COM2003-00250 COM2003-00250 COM2003-00250 Payments: Type of Payment Check Paid By Description Add, Alter, Extend Circ Receipt #: 2200200000000000732 Date: 04/11/2003 Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee ROBERT B. ROGERS Received By Check Number Confirm No nJm 2186 Page I of I '. 4/11/2003 8:59:53AM , City of Springfield Development Services Department Public Works Department Official Receipt Amount Paid 43.00 3.00 3.22 4.60 Line Item Total: $53.82 How Received Amount Paid In Person 53.82 $53.82 Payment Total: cRcceipt.rpt